Idiopathic scoliosis is a pathology that affects approximately 2% of adolescents [1
]. Various treatment procedures are proposed, according to severity of curvature, hump height, age at diagnosis, spinal stiffness and skeletal maturity. One of the major problems in the treatment of this pathology is the lack of a reliable prognostic tool for its possible evolution. There are scolioses that, once discovered, don't worsen anymore, whereas others are characterized by a rapid and dramatic worsening – especially during the pubertal growth spurt – or that continue to worsen in adulthood. This particular variety of behaviours allows us to employ two alternative methods of therapeutic approach:
1. The patients are not subjected to screening or to previous treatments. This forces the persons who are affected by serious scoliosis to begin treatment later, causing negative repercussions on the final results or the need to perform an important surgical intervention.
2. The patients are subjected to a screening (school, family, pediatrician); all risky scolioses are identified (namely those that exceed a certain degree according to age) and are referred to a program of conservative treatment, according to the potential risk of evolution. Furthermore, this procedure has a disadvantage in that it involves a long and expensive treatment even for the subject who is not affected by an progressive scoliosis.
The steps of non-surgical intervention can start with a simple observation, if no particularly important curvature is discovered and the subject is not at a particularly risky age. Alternatively, it is possible to adopt different therapeutic solutions, such as the use of braces [3
], which are intended to correct spinal development when curvature evolution is not controlled through other techniques. Many studies have been conducted regarding the efficacy of such a therapeutic approach, whose validity is nevertheless confirmed by official medicine [5
]. Another common therapeutic approach is the use of physical exercises [17
] whose efficacy is not universally recognized, even if two systematic review [28
] has been published during recent years. The results of these works do not allow us to state with reasonable certainty that this procedure will represent an efficacious treatment for idiopathic scoliosis, given that the studies on which the aforementioned review were based had been performed using different techniques. However, the possibility of comparing the best results from the various treated groups with the respective control groups encourages us to carry out new research with a better scientific design [28
]. Besides the above-described treatments, it is possible to mention a range of alternative therapeutic proposals, such as the implantation of a dental bite or of podalic insoles. Their efficacy, however, has not been supported by published studies. A therapeutic approach that seems more and more common for the conservative treatment of adolescent idiopathic scoliosis includes manual techniques proposed by chiropractors and osteopaths. These techniques are favoured by their progressive popularity within the wider and wider panorama of alternative therapies [30
The purpose of this study is to present a systematic review of the international scientific literature in order to verify the therapeutic efficacy of these procedures, which include all the manipulative and generally passive techniques performed by an external operator to treat idiopathic scoliosis. In a more specific meaning, osteopathic, chiropractic and massage techniques have been considered manipulative therapeutic methods.